1.In-stent restenosis assessed with frequency domain optical coherence tomography shows smooth coronary arterial healing process in second-generation drug-eluting stents.
Takashi KAJIYA ; Hiroshi YAMAGUCHI ; Junichiro TAKAOKA ; Kengo FUKUNAGA ; Ryoichi ARIMA ; Akihiro MIYAMURA ; Toshiko NINOMIYA ; Nobuhiko ATSUCHI ; Yoshihiko ATSUCHI ; Mitsuyasu TERASHIMA ; Hideaki KANEDA ; Mitsuru OHISHI
Singapore medical journal 2019;60(1):48-51
INTRODUCTION:
The pathophysiology and mechanism of in-stent restenosis (ISR) after implantation of second-generation drug-eluting stents (DESs) are not fully clear. We compared the morphological characteristics of ISR between first- and second-generation DESs using frequency domain optical coherence tomography (OCT).
METHODS:
Patients who underwent follow-up coronary angiography (CAG) after first-generation (CYPHER™ and TAXUS™) and second-generation (Nobori®, PROMUS Element™, Resolute Integrity and XIENCE) DES implantations were examined. ISR was defined as lesions of over 50% diameter stenosis at follow-up CAG. Frequency domain OCT was performed at the time of revascularisation of ISR. Tissue morphology was assessed at minimum lumen area. OCT images of DESs at both early (≤ 1 year) and late (> 1 year) phase follow-up were compared.
RESULTS:
On qualitative OCT assessment, the ratios of homogeneous, layered, heterogeneous without-attenuation and heterogeneous with-attenuation morphologies were 57.1%, 17.1%, 20.0% and 5.7%, respectively, for second-generation DES ISR (n = 35), and 16.7%, 25.0%, 25.0% and 33.3%, respectively, for first-generation DES ISR (n = 36). At late phase follow-up, homogeneous morphology was significantly more common for second-generation DES ISR compared to first-generation DES ISR (first-generation: 8.0% vs. second-generation: 50.0%; p < 0.01) while heterogeneous with-attenuation morphology was significantly more common for first-generation DES ISR (first-generation: 44.0% vs. second-generation: 5.6%; p < 0.01).
CONCLUSION
Homogeneous tissue morphology was more frequently found for second-generation than first-generation DES ISR, especially in the late phase. This suggested that neointimal hyperplasia was the main mechanism in second-generation DES ISR, and that the neointima was stabilised, much like in bare metal stent implantation.
Aged
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Constriction, Pathologic
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pathology
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Coronary Angiography
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Coronary Restenosis
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diagnostic imaging
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pathology
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Coronary Vessels
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diagnostic imaging
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pathology
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surgery
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Drug-Eluting Stents
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adverse effects
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Female
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Humans
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Incidence
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Male
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Metals
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Middle Aged
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Neointima
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Retrospective Studies
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Tomography, Optical Coherence